It’s done in a special room called the EP (electrophysiology) lab.

How Should I Prepare for It?

If you're scheduled for a head-up tilt table test, you should:

• Take all your medications, as prescribed.
• Not eat or drink anything after midnight the evening before your test. If you must take medications, drink only small sips of water to help you swallow your pills.
• Bring a list of all your current medications, including the dose.
• Wear comfortable clothes to the hospital. It is best not to wear any jewelry or bring valuables.
• Plan to have someone drive you home after your test.
• If you have diabetes, ask how to take your medications, eat, and drink before the procedure.

What Should I Expect?

It usually takes an hour or two to complete. That may vary, depending on how your blood pressure and heart rate change and what symptoms you have during it.

Before the test begins, a nurse will start an IV. This is so the doctors and nurses may give you medications and fluids during the procedure if necessary.

The nurse will connect you to four monitors. They are:

Defibrillator/ pacemaker: This is attached to one sticky patch placed on the center of your back and one on your chest as a precautionary measure. The device allows the doctor and nurse to increase your heart rate if it’s too slow or send energy to your heart if its rate is too fast.

Electrocardiogram, or EKG : It’s attached to several sticky electrode patches that are put on your chest. It provides a picture of the electrical impulses going through your heart.

Oximeter monitor: A device is attached to a small clip on your finger. It checks the oxygen level of your blood.

Blood pressure monitor : It’s connected to a blood pressure cuff on your arm and checks your blood pressure every so often.

You may feel nothing at all, or you may feel like passing out. Some people do pass out. It is important to tell your doctor or nurse about any symptoms you feel.

As part of the test, your doctor may give you a medication called Isuprel or a nitroglycerin spray under your tongue. This may make you feel nervous or jittery. You may feel your heart beat faster or stronger. This feeling will go away as the medication wears off.

Most likely, you’ll be able to go home. You should have someone drive you. Your doctor may change your medications after they get your test results. They also may tell you that you need new medications or more tests or procedures.

Tilt Table Test for Children

What is a tilt table test for children?

The tilt table test is done to find the cause of fainting (syncope). Syncope is a brief loss of consciousness and muscle tone (or posture) when not enough blood gets to the brain. In children, fainting is usually harmless. But in some children, fainting can be serious. This is usually because of a heart problem, or sometimes a neurological problem. Tilt table testing is done with a special table or bed that changes a child's position from lying to standing. The child's blood pressure and heart rate are checked while the child is in the different positions.

Why might my child need a tilt table test?

If your child has episodes of fainting,the healthcare provider may advise a tilt table test. Syncope can have many different causes. It may happen only rarely or it can happen often. Some causes of syncope may include:

• Vasovagal syndrome (or neurocardiogenic/reflex syncope). A sudden drop in blood pressure occurs with or without a decrease in heart rate. It is caused by an exaggerated but normal nerve response to some triggering event that can affect the heart and blood vessels. This is the most common cause of syncope. It can follow periods of extreme emotion. It is generally a benign condition. A tilt table test is most commonly done to confirm this condition if it is suspected. .

• Arrhythmia. The heart rate is too slow, too fast, or too irregular to keep enough blood flowing to the body, including the brain. This is a rare, but potentially dangerous cause of syncope.

• Structural heart disease (muscle or valve defects). There may be problems with the heart muscle or one or more of the heart valves. This may cause a decrease of blood flow to the body, including the brain. Inflammation of the heart muscle known as myocarditis may also cause fainting. The heart muscle becomes weak and is not able to pump as well as normal. The body again reacts to decreased blood flow to the brain by fainting.

• Orthostatic hypotension. This is a drop in blood pressure that occurs when a person has been standing for a while, or changes when a person goes from a sitting to a standing position. Blood pools in the legs, preventing a normal amount of blood from being pumped to the brain. This brief drop in blood flow to the brain causes a person to faint. This is more common in older adults.

Other problems that can cause or imitate syncope include:

• Head injury

• Seizure

• Stroke

• Inner ear problems

• Dehydration

• Low blood sugar

• Breath holding episodes (typically in younger children between the age of 6 months and 2 years)

• Anemia

• Mass or tumor in the brain

• Aneurysm or abnormality of a blood vessel in the brain

• Urination or having a bowel movement

• Coughing

When a healthcare provider sees a child with fainting episodes, they will carefully check the child's medical history and do a physical exam. Tests include an electrocardiogram (ECG) and often an ultrasound exam of the heart (echocardiogram). If the exam or history does not reveal a cause for the fainting, and the child has no history of a heart condition, then further tests, such as a tilt table test, may be done. 

What are the risks of a tilt table test for a child?

The primary risk for your child during a tilt table test is fainting. If fainting does occur, your child is in a safe, supervised setting and will not be hurt.

How do I get my child ready for a tilt table test?

Your child should not eat or drink for a certain amount of time before the test. Talk with your child's healthcare provider about the specific amount of time.

What happens during a tilt table test for a child?

A tilt table test may be done in a special clinic or in the hospital. It may last from 30 to 90 minutes. The test has 2 parts as follows:

Part 1

• Your child will lie on a special table or bed. Straps will be placed across their chest and knees to help them stay in the correct position.

• A healthcare provider may put an intravenous (IV) line in one of your child's arm veins to give medicine.

• The provider will put a blood pressure cuff on one of your child's arms to check blood pressure throughout the test.

• The provider will attach electrodes with wires to your child's chest. The wires are attached to an electrocardiogram (ECG). This machine will let the provider monitor your child's heart rhythm throughout the test.

• The provider will tilt the table so that your child's head is higher than their body. Your child will stay in that position for several minutes. The provider will watch for changes in your child's blood pressure and heart rhythm. The provider will also watch your child for dizziness, fainting, and other symptoms.

• The provider may raise tilt the table even higher or repeat this part of the test while watching for changes in your child's blood pressure and heart rhythm.

• If your child's blood pressure drops and/or if syncope is reproduced, the provider will end the test and promptly have the table placed in flat position.

Part 2

• If there are no changes in blood pressure, the provider may decide to give your child medicine through the IV line. Isoproterenol or nitroglycerin are the two most commonly used medications. The medicine may either cause your child's heart to beat faster and harder or cause the blood pressure to go lower. This makes your child more sensitive to the changes in positions. 

• The provider will tilt the table so that your child's head is raised. They will watch for changes in your child's blood pressure and heart rhythm.

• The provider will stop the test and the medicine and place the table in the flat position if your child's blood pressure drops. If it does not drop, the provider will end the test after watching your child's blood pressure and heart rhythm for a while.

What happens after a tilt table test for a child?

Your child may feel tired and nauseated for a while after the test. They will be watched for about 30 to 60 minutes. You healthcare provider may give you specific instructions. Test results are often available in a few days.

The test may not cause any symptoms, or changes in your child's ECG or blood pressure. If so, your child may need more tests or procedures to find the cause of the syncope.

Next steps

Before you agree to the test or the procedure for your child, make sure you know:

• The name of the test or procedure

• The reason your child is having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• When and where your child is to have the test or procedure

• Who will do the procedure and what that person’s qualifications are

• What would happen if your child did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or your child has problems

• How much you will have to pay for the test or procedure

Tilt Table Test

Definition

During a tilt table test, a person lies on a table. The table is then tilted from lying down to an upright position. The person’s heart rate and blood pressure are checked throughout the test.

Blood Flow to the Brain

Fainting may be due to decreased blood flow to the brain.

Reasons for Test

A tilt test is done to help diagnose the cause of unexplained fainting. The test tries to create the same conditions that may cause a person to faint.

Possible Complications

This test may lead to lightheadedness or fainting. If so, the care team will be there to help.

What to Expect

Prior to Test

You may be asked not to eat or drink for 2 to 4 hours before the test.

Description of Test

Electrode patches will be placed on the chest, legs, and arms. These patches connect to an ECG. An ECG is a device that checks the heart's electrical activity. Next, a blood pressure cuff will be placed on the arm to check blood pressure. An IV may also be placed in the arm. This is to take a blood sample or give medicine—if needed.

You will lie flat on a table. Safety straps will secure you. The table will be raised slowly until upright. You may stay in this position for 5 to 45 minutes. It depends on the reason for the test.

Your blood pressure and heart rate will be checked. While upright, you will need to stay as still as possible. You will be asked you how you feel throughout the test. If you faint or feel like you might faint, the table will be returned to a lying down position. If you do not faint, you may be given a medicine that can help with the diagnosis.

After Test

You can go home.

How Long Will It Take?

About 90 minutes

Will It Hurt?

During the test some people feel sick, lightheaded, or a fast heartbeat. The IV may cause some discomfort when first put in.

Call Your Doctor

Call your doctor if you have:

• More fainting
• Lightheadedness
• Nausea and vomiting
• Fast heartbeats
• Blurred vision
• Problems breathing
• Chest pain